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Northern Ireland's uncaring A&E units: Dementia patients sent home alone in taxis at night, self-harm victims treated with hostility, dignity denied to the dying

By Adrian Rutherford

Patients are dying without dignity as care and support are no longer deemed a priority in Northern Ireland's emergency departments, a report has found.

Some were left in agony, with no access to food or water, by staff who showed disregard for their well-being.

Older people felt they were deliberately pushed down the priority list, while self-harmers described being treated with hostility.

Ensuring maximum dignity for end of life patients "is not always prioritised", the report said.

One woman told how hospital staff asked for the body of her dead husband to be moved to an old plaster room.

The horror stories emerged during an inquiry into the standard of care in A&Es.

The probe by the Northern Ireland Human Rights Commission (NIHRC) heard accounts of inhuman and degrading treatment.

However, its report, published today, does not find evidence of "systemic violations" of human rights.

Yet patients' stories indicate a growing crisis in our emergency departments.

The worst examples include:

• Patients left without pain relief and with no access to food and fluids.

• A perceived disregard, lack of attention or kindness from some health professionals.

• Dismissive attitudes towards older people.

• Victims of self-harming denied compassion and treated with hostility.

A human rights inquiry into emergency health care was launched in June 2014.

It was the first time anywhere in the world that emergency health care had been the subject of such an investigation.

Eleven public hearings were held, with 139 witnesses giving evidence.

Today's report makes more than 100 findings, including issues surrounding dignity.

It states how staff are striving to maintain patient dignity in an often challenging and crowded environment.

Patients with less common conditions reported negative experiences, including feeling laughed at.

"The core complaint was that staff did not listen to the patient which at times appeared to result in improper medical treatment," the report states.

"This impacted upon the patients' willingness to attend in the event of future emergencies."

Concerns were also raised about older patients, particularly those with dementia, being transferred alone at night in taxis.

The inquiry heard £25m of the funding assigned to Transforming Your Care (TYC) - the road map for improving Northern Ireland's health service - has been spent on resettlement of patients with mental health and learning disability patients into the community.

However, the commission said this was not what the TYC transition funds were designed to achieve. The report's 26 recommendations include a call for dedicated minimum care standards.

Chief commissioner Les Allamby said a human rights-based approach can improve emergency care services for patients and staff.

"The commission heard individual cases which amounted to inhuman and degrading treatment, but did not discover evidence of systemic violations of human rights," he said.

A Department of Health spokesman said the report represented a "comprehensive and important piece of work". "Similar issues were highlighted by the Regulation and Quality Improvement Authority (RQIA) in its inspection of the Belfast Trust in 2014," it said.

"The minister at that time commissioned the RQIA to carry out a comprehensive review of emergency and unscheduled care and published its report in July last year. The then minister also established a task group to implement the RQIA's recommendations. A follow-up inspection of the Belfast Trust late last year found that there had been significant improvement."

The Health and Social Care Board said funding from Transforming Your Care (TYC) was not used in the resettlement of people from long stay institutions. 

"The resettlement programme pre-existed the TYC report and the decision was taken to include it as part of TYC as it represented a significant shift from hospital-based to community-based care.  The resettlement programme had its own separate funding stream," it said today.

Case notes: Four patients' stories

Richard Watson visited Causeway Hospital’s emergency department three times during May and June 2014 due to chest pains and breathlessness. Each time he sensed that staff were “run off their feet”.

On his second visit, Richard said he asked for a pillow and painkillers but received neither. Eventually his partner Janet had to make a pillow using her coat and a towel she had with her.

When asked how he felt treated by the doctors and nurses, Richard replied: “You could actually see they did what they could; they spent as much time as they could, because they had to rush off to do somebody else.”

Tony O’Reilly, who has cerebral palsy, was taken to Altnagelvin Hospital by ambulance in June 2007 experiencing severe pain.  Arriving at around 3am on a Sunday morning, he was asked if he had taken alcohol or drugs.

“I explained to the nurse that I hadn’t taken any alcohol and that as a general rule I don’t drink and that I wasn’t on any drugs,” said Tony, adding it was clear the nurse did not believe him. He was given painkillers and told after a couple of days he would be fine. Tony went home. “Bar one male nurse, nobody showed any compassion, any understanding,“ he said.

When Sam Kilpatrick, who is blind, visited the Lagan Valley Hospital he was put on a trolley in a room but given no buzzer to call for assistance,.

“I needed to go to the toilet, but I was in a private room and I had no way of alerting a nurse,” he said. “I had to ring Lagan Valley Hospital reception on my mobile and get put through to casualty in order to speak to someone.”

After the nurse took Sam to the toilet, he asked if she could look in on him every 20 to 30 minutes, but was told staff were busy. “The nurse’s manner was not nice. A different nurse did pop her head in 20 minutes later. I felt generally hurt by the manner in which I was treated. This experience makes me dread going to hospital.”

Johnny* was reported missing in the morning. He was found by the PSNI later that day with slit wrists and taken to Belfast City Hospital’s emergency department.

Due to Johnny’s habit of walking out, his sister Julie telephoned the reception asking them not to let him leave before family could arrive.

Despite the hospital classifying Johnny as high risk, they still let him go out to smoke and get food unsupervised.

“He was there until 1am and he should have been sectioned but this never happened,” said Julie. “They couldn’t section him until another doctor signed him off. The doctor never arrived to do this and Johnny left without (receiving) the help that he needed.”

After leaving Belfast City Hospital, Johnny went to the Lagan Valley Hospital to seek help. The hospital has no record of him being there. Julie told the inquiry how Johnny died by suicide later that day “despite all his attempts for help (and) all the time he spent in A&E”.

* Full name withheld

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